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Navy S Marine Corps Medical News 


August 4, 2000 

Navy and Marine Corps Medical News (MEDNEWS) is a weekly 
compendium of news and information contributed by commands 
throughout the Navy medical department . Information contained 
in MEDNEWS stories is not necessarily endorsed by Navy Bureau of 
Medicine and Surgery (BUMED) , nor should it be considered 
official Navy policy. 

BUMED distributes MEDNEWS to Sailors and Marines, their 
families, civilian employees and retired Navy and Marine Corps 
families. Further distribution is highly encouraged. 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional ' s name to show affiliation: MC - Medical 
Corps (physician) ; DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers) . Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names. 


Contents for this week's MEDNEWS: 

- Pax clinic improves access 

- Humanitarian visit to Western Samoa 

- NMCP meets the needs of patients with Heart Failure 

- Information age hits military treatment facilities 

- Anthrax question and answer 

- TRICARE question and answer 

- Healthwatch: The Pap Test - How and why it can help women? 



Headline: Clinic improves access to medical appointments 

By Jim Jenkins, NAS Patuxent River Public Affairs Department 

PATUXENT RIVER, Md. - Patuxent River Naval Medical Clinic 
is now offering improved access for its patients. 

Patients will no longer call to schedule an appointment for 
a routine well child visit and hear the scheduler say they can't 
be seen until the next month. For the last few weeks the clinic 
has been operating on an open access appointment system to 
ensure patients are seen the same day they call. 

"Open access is a system to enhance the access from the 
patients perspective, " said Capt. Ralph Puckett, commanding 

The Pax River Clinic is a leader in implementing such a 
system in the Department of Defense and will serve as a test bed 
for open access throughout the military health care system. 

"Traditionally Navy medicine has employed something called 

a carve out approach to appointments where you freeze a certain 
set of appointment slots per day and put them aside, " said Lt. 
Cmdr. Micah Meyers, director for administration. 

Slots are held because providers expect to get a bunch of 
walk-ins at the end of the day. In reality, whenever a set of 
appointments are carved out each day for this population, access 
is restricted to patients who have appointments or are seeking 
appointments . 

In addition, Puckett said that many patients were put off 
by having to tell an appointment taker a myriad of personal 
information before being told when they could see their doctor. 
Many times patients didn't see the same doctor on a continuous 
basis. For the most part, Puckett said, the old system 
accommodated the acutely ill patients, but not many of the 
routine patients . 

Open access marries each patient with one physician who 
then becomes that patient 's primary physician. This is called 
PCM by name. When patients call for appointments, the scheduler 
asks who is their physician and if the patient would like an 
appointment the same day. Open access gives the patient the 
ability to seek and receive primary care with their provider of 
choice, at the time the patient chooses. 

"You get to see the doctor when you want to, not when the 
system dictates when you can get in, " Puckett said. "It's so 
different that some patients are taken aback, " said Puckett . 

Meyers added that the open access system dovetails 
perfectly with the Navy's current drive towards optimization. 
"It is right in line with what the Navy's trying to do, " said 
Meyers. "In the two weeks we've been doing this we've close to 
doubled the number of daily open appointments each day here at 
this command. " 


Headline: Prenatal care brought back to naval hospital after 
14-year hiatus 

By LT Youssef H. Aboul-Enein, MSC, Naval Hospital Great Lakes 

GREAT LAKES, 111 . - This summer, Joseph Michael Russell 
became the first baby in 14 years to be born with the prenatal 
oversight of the Great Lakes Naval Hospital Obstetrics staff. 

Although he was born at Condell Medical Center, the vital 
part of monitoring the infant ' s fetal development occurred at 
Naval Hospital Great Lakes. 

"I reported in March from Kings Bay Submarine Base and was 
apprehensive at the prospect of changing doctors, " said new 
mother PN1 Dawn Russell . She added that her doctor was 
wonderful answering all her questions and involving her husband 
PN2 Michael Russell in the prenatal care. 

"Getting back into the pre-natal care business made 
absolute sense. Aside from the fiscal benefits, it is 
convenient for new mothers of the Naval Training Center Great 
Lakes community to get this care after work or during their 
lunch break, " said Capt . Elaine Holmes, MC, commanding officer. 

Holmes explained how in the coming months the new baby will 
be assigned one of several pediatricians who will be the primary 

care manager while his parents are serving at Great Lakes. 


Headline: Humanitarian visit to Western Samoa 

By Evelyn B. Riley, U.S Army Center for Health Promotion and 

Preventive Medicine 

WESTERN SAMOA - More than 640 natives of Samoa can now see 
thanks to a team of Navy optometrists. 

The three-man team, led by Lt. Kenneth Whitwell, MC, 
conducted eye exams and provided prescription glasses to 
medically deprived people on the outlying villages of this 
developing country located halfway between Australia and Hawaii . 

During three days, Whitwell, along with HM2 David Pfeiffer 
and HM3 Jeremy Geer, opticians assigned to the Navy Ophthalmic 
Support and Training Activity, Yorktown, Va. , administered more 
than 200 exams a day. 

"The people of Samoa were extremely gracious, wonderful and 
interesting patients . They were very cooperative and did not 
mind waiting to be seen, " said Whitwell. "It was easy for us to 
muster up the energy and work so many hours as they were all so 
grateful for us being there. " 

The team said they would never forget the reaction of a 16- 
year-old boy whose nearsightedness was so great that anything 
beyond five-inches was a blur. He had never been to a doctor 
and returned to tell the team that he could see his parent's 
faces for the first time in his life. 


Headline: NMCP meets the needs of patients with heart failure 
By Lt. Clifford C. Pyne, Naval Medical Center Portsmouth 

PORTSMOUTH, Va. - Patients with congestive heart failure 
(CHF) oftentimes require frequent hospitalizations. But current 
research has proven that many of these hospitalizations can be 
avoided through intensive outpatient management . 

The Heart Failure Clinic at NMC Portsmouth has been 
developed to meet the needs of patients with congestive heart 
failure. The clinic was developed to decrease the frequency of 
hospitalizations and emergency room visits and enhances the 
quality of life for patients with CHF. 

Patients are enrolled in the clinic by request from their 
Primary Care Physician or a referral can be made. 

After the initial visit, patients are followed at least 
once a week for six weeks. During their time at the clinic, 
patients will receive a variety of educational materials 
designed to help them become more knowledgeable of the disease 
process and medications. The patient's progress through this 
initial phase depends on their ability to tolerate the 
prescribed therapies. 

The clinic has been a great success and well received by 
the patients and staff. Current enrollment stands at 65-70 
patients . Of those patients, only four percent have returned to 
the hospital within the past year as a result of CHF. 


Headline: Information age hits military treatment facilities 
By Lt.T Youssef H. Aboul-Enein, MSC, Naval Hospital Great Lakes 

GREAT LAKES, 111 . - Naval Hospital Great Lakes is working 
to bring several Electronic Health (E-HEALTH) initiatives on- 

"Based on the success of these programs the future of Navy 
Medicine will involve empowering not only physicians and 
healthcare providers but patients in the quest for more robust 
and prompt medical care and access using the Internet, " said 
Capt. Raymond Swisher, MSC, Naval Hospital executive officer. 

Among the programs being tested and piloted at Great Lakes 
is the Clinical Practice Guidelines initiative . In the coming 
months doctors, nurses and corpsmen will have access to a 
guarded website and be able to download the latest information 
and treatment plans on everything from depression to sinus 
problems. These evidence based guidelines draw from a database 
of recent literature and clinical practices that will help 
patients and providers in choosing appropriate healthcare for 
specific clinical conditions. 

"Many of us do not have the luxury to read every 
professional journal and synthesize the information to put into 
practice in the clinic. This website will enable us to do just 
that and keep current with clinical decisions that are based on 
the best available evidence and research, " said Capt . Kenneth 
Hoyle, MC, director of psychosocial services. 


Headline: Anthrax question and answer 

Question: Is it unusual for a vaccine to be manufactured by 
only one company in the United States? 

Answer: No. More than 40 percent of FDA-licensed vaccines 
are produced by only one manufacturer. These include: cholera 
vaccine, Japanese encephalitis vaccine, Lyme disease vaccine, 
meningococcal vaccine, mumps vaccine, injectable poliovirus 
vaccine, oral poliovirus vaccine, rubella vaccine, live typhoid 
vaccine, varicella vaccine, and yellow fever vaccine. 

Vaccines available from multiple manufacturers include: 
diphtheria toxoid, tetanus toxoid, pertussis vaccine, 
Haemophilus influenzae type b (Hib) vaccine, hepatitis A 
vaccine, hepatitis B vaccine, influenza vaccine, pneumococcal 
vaccine, injectable typhoid vaccine, and rabies vaccine. 


Headline: TRICARE question and answer 

Question: If I am participating in TRICARE Standard, do I 
have to pay for medical care at a MTF? 

Answer: There aren't any out-of-pocket costs for 
outpatient care received at an MTF. However, it is important to 
remember that TRICARE Prime enrollees will receive priority for 
care at that MTF before non-enrolled beneficiaries . You will be 
seen on a space-available-basis only. 


Headline: Healthwatch: The Pap Test 

- How and why it can help 


By Lt. Cmdr. Lauren Rodler, US Naval Hospital Yokosuka 

YOKOSUKA, Japan - Since the Pap test was initiated as a 
routine procedure fewer women have died from cervical cancer. It 
is a silent disease that usually shows no symptoms and 
progresses slowly in its early stages. That is why a yearly Pap 
test can detect cell changes before they turn cancerous. The 
Pap smear is a painless procedure in which cells are scraped 
from the cervix and/or vagina and sent to a specialist to look 
for abnormal changes in the cells. 

Who is at increased risk of getting cervical cancer? 

People who smoke, have a history of sexually transmitted 
disease or have had sex at a young age are at the greatest risk 
for cervical cancer. 

What do the results mean? 

You should receive communication from the hospital or 
clinic either as a letter or a telephone call about your health 
results. It is very important that we have your current address 
and telephone number in order to reach you. It is also 
important that if you don 't hear from the clinic in the 
prescribed time, you should call to obtain your results. 

If the results are normal then follow up as instructed by 
your provider . 

If the results are abnormal then return for additional 
tests. An abnormal result does not mean you have cancer. It may 
be necessary to repeat the Pap test in three to four months or 
to have an exam that looks more closely at the cervix. 

Remember that the Pap test is to discover abnormal cells 
preferably before they change into cancer cells. 


Comments about and ideas for MEDNEWS are welcome . Story 
submissions are encouraged. Contact MEDNEWS editor, at email:; telephone 202-762-3218, (DSN) 762, or 
fax 202-762-3224.